scholarly journals Atypical Bacterial Growth within Units of Platelets Challenges Transfusion Medicine Dogma

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Eric A. Gehrie
Keyword(s):  
Bacterial Contamination ◽  
Current Issue ◽  
Safety Concern ◽  
Positive Culture ◽  
Storage Period ◽  
Transfusion Medicine ◽  
Platelet Concentrates ◽  
Content Type ◽  
Platelet Storage ◽  
Positive Culture Result

ABSTRACT Although transfusion-transmitted bacterial infection is relatively rare, mitigation of bacterial contamination of platelet units is arguably the top current transfusion-related safety concern. Several different technologies have been employed to detect or neutralize bacteria in platelet concentrates. However, studies of the efficacy of these systems have been hampered by problematic definitions of what represents a “true-positive” versus a “false-positive” culture result. In the current issue of the Journal of Clinical Microbiology (M. Cloutier, M.-È. Nolin, H. Daoud, A. Jacques, M. J. de Grandmont, É Ducas, G. Delage, and L. Thibault, J Clin Microbiol 56:e01105-18, 2018, https://doi.org/10.1128/JCM.01105-18), it was demonstrated that the growth of Bordetella holmesii is inhibited by the platelet storage environment, which may explain why the results of initial positive platelet cultures are not always confirmed by subsequent cultures later during the storage period. This important finding is at odds with the generally held belief within the field of transfusion medicine that initially positive platelet cultures that are not confirmed on repeat testing are instrumentation-based false positives. The clinical risk profile of organisms demonstrating storage-related low viability is worthy of further study.

scholarly journals Effects of use of riboflavin and ultraviolet light for pathogen inactivation on quality of platelet concentrates

2011 ◽  
Vol 68 (6) ◽  
pp. 489-494 ◽  
Author(s):  
Zoran Stanojkovic ◽  
Ana Antic ◽  
Miodrag Stojanovic
Keyword(s):  
Uv Light ◽  
Storage Period ◽  
Buffy Coat ◽  
Blood Products ◽  
Pathogen Inactivation ◽  
Platelet Concentrates ◽  
Platelet Storage ◽  
Control Units ◽  
The Moment ◽  
Uv Rays

Background/Aim. Pathogen inactivation in blood and blood products is one of the major means to achieve a zero risk blood supply and improve transfusion safety. Riboflavin (vitamin B2) activated by ultraviolet (UV) light, produces active oxygen which damages cell membrane and prevents replication of the carrier of diseases (viruses, bacteria, protozoa) in all blood products. The aim of this study was to establish the influence of the process of pathogens photoinactivation using riboflavin and UV rays on the biochemical and functional characteristics of platelet concentrates prepared from ?buffy coat?. Methods. The examination included 80 platelet concentrates prepared from ?buffy coat?, which was separated from whole blood donated by voluntary blood donors around 6 hours from the moment of collection. Concentrates were pooled, filtered and separated unton two groups: one consisted of 10 control units and the other of 10 examined units (pooled platelet concentrates). Examined units of the platelets were treated by riboflavin (35 mL) and UV rays (6.24 J/mL, 265-370 nm) on Mirasol aparature (Caridian BCT Biotechnologies, USA) in approximate duration of 6 min. A total of 35 mL of saline solution was added to the control units. The samples for examining were taken from the control and examined units initially (K0, I0), after the addition of saline (K1) and riboflavin (I1), after illumination (I2), first day of storage (K3, I3) and the fifth day of storage (K4, I4). The following parameters were measured: platelet count and platelet yield, residual erythrocyte and leukocyte count, pH, pO2, pCO2 and bacterial contamination. Results. All the measured parameters showed a statistically significant decrease comparing to K0 and I0; all the results of the first day of platelet storage showed statistically significant decrease comparing to K1 and I1, and all the results of the fifth day of platelet storage (K4, I4) showed a statistically significant decrease comparing to K1 and K3 and to I1 and I3. There was no the mentioned difference in the measured parameters between K4 and I4 (the end of storage - the fifth day). All the platelet units were sterile till the seventh day, when the investigation ended. Conclusion. Platelet concentrates inactivated by riboflavin and UV rays (Mirasol PRT sistem, Caridian BCT, USA) keep all the characteristics assessed by the Guide to the preparation, use and quality assurance of blood components (Council of Europe), during the whole storage period (five days). The obtained data were correlated with existing up to date literature and demonstrated that Mirasol treated platelets were safe and could be incorporated effectively in the routine blood bank and transfusion setting.

scholarly journals Bordetella holmesii Contamination of Platelet Concentrates: Revisiting the Definition of a Positive Culture

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Marc Cloutier ◽  
Marie-Ève Nolin ◽  
Hana Daoud ◽  
Annie Jacques ◽  
Marie Joëlle de Grandmont ◽  
...  
Keyword(s):  
Positive Culture ◽  
Blood Products ◽  
Platelet Concentrates ◽  
Bacterial Strains ◽  
Culture Bottle ◽  
Decision Algorithm ◽  
Content Type ◽  
Infectious Risk ◽  
Definition Of

ABSTRACT Bacterial contamination remains the most important infectious risk of platelet transfusion. After an initially positive result, a second test is performed on the blood products and the initial culture bottle to confirm the contamination. Based on the blood center's decision algorithm used, results can be either confirmed negative, positive, or indeterminate, or be unconfirmed or discordant. Here, we report the first cases of platelet concentrates contaminated with Bordetella holmesii. The in vitro growth characteristics of this unusual contaminant in platelet concentrate were investigated. Two B. holmesii strains isolated from platelet concentrates, as well as a control strain (Serratia marcescens), were spiked into platelet concentrates (PCs) at 1 and 10 CFU/ml. PCs were stored at 20 to 24°C under agitation. Samples were collected on days 2, 3, 4, and 7 for colony count and for bacterial screening using the BacT/Alert 3D system. Two PCs were detected as being positive for B. holmesii. However, recultures were negative. In vitro, B. holmesii did not grow but remained detectable in PCs. Its viability diminished rapidly in contact with human plasma. Upon screening using the BacT/Alert 3D system, the majority of products spiked with B. holmesii were negative. This is the first description of PCs contaminated with B. holmesii. This bacterium survives in blood products and remains dormant at low concentrations in blood products stored at room temperature, thus making difficult its detection with the BacT/Alert 3D system. The present definition of a true-positive culture of PCs may be overly restrictive for certain bacterial strains.

FIBRONECTIN CONTENTS AND LEVELS IN BLOOD COMPONENTS DURING STORAGE

1987 ◽  
Author(s):  
N Müller ◽  
U Velten
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Storage Period ◽  
Functional Tests ◽  
Platelet Concentrates ◽  
Platelet Storage ◽  
Turbidimetric Assay ◽  
Effective Use ◽  
Plastic Containers ◽  
Packed Rbcs

Fibronectin has been proposed to have an antithrombotic effect, protecting against platelet and fibrinogen consumption after injury. For the supply of platelets the possibility of extending platelet storage is important forthe management of platelet logistics. This study was designed to determine the effect of storage on the contents and levels of fibro-nectin (FN) in whole blood and components suchas packed RBCs, PRPs and platelet concentrates (PC) in two different plastics. For care of critically ill patients the FN present in components often used in large amounts could supplement the use of purified FN as a source of this opsonic protein. FN protein was assayed using an electroimmunoassay as well as a turbidimetric assay for quantitative determination at 2 day intervals during storage of CPDA-1 stabilized red cells at 4° C for 35 days and daily during end-over-end rotational storage of platelets at 22° C in conventional plastic containers (I) and trimellitate plasticised polyvinylchlo-ride bags (II) (F-763 Biotest). Moreover platelet functional tests, fibrinogen, F XIII and F VIII-complex were tested. FN levels in red cell componentsgradually decreased during storage until to 40% of the initial levels. Platelets maintained a concentrationof 404 ±70 ug/dl (I) and 378±66 ug/dl(II). There were no significant differences between the values determined in the two differentbags over the 8-days storage period. This study demonstrate the stabilityof FN protein during storage and formore effective use of limited donor resources the FN content of each of these products should be considered when determing the dose of FN for replacement therapy in critically ill patients with FN depletion following trauma and surgery.

scholarly journals The pre-eminence of patient safety in health care governance

2017 ◽  
Vol 22 (1) ◽  
pp. 61-66
Author(s):  
Fiona MacVane Phipps
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Design Methodology ◽  
Current Issue ◽  
Common Theme ◽  
Review Section ◽  
Content Type ◽  
Review Editor ◽  
The Subject ◽  
Health Care Governance

Purpose The purpose of this paper is to identify a common theme linking the articles in this issue of IJHG. The review editor elucidates on this topic while presenting key findings from the articles which comprise the current issue. Design/methodology/approach The design is a general review describing the articles under review while expanding on the subject matter through reference to other authors. Social implications The Review provides readers with a brief overview of the current articles enabling them to select the ones which reflect their needs or interests. Originality/value IJHG is the only Emerald journal providing a Review section of this type.

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p < 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p < 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

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